Antipsychotics

Question 1

Low potency typical antipsychotics

Answer 1

Chlorpromazine
Thioridazine

Anticholinergic: delirium, drying of secretions, constipation, urinary retention, mydriasis – block M receptors

Sedation: block histamine receptors

Orthostatic hypotension – block alpha 1 receptors

Question 2

High potency typical antipsychotics - neuroleptics

Answer 2

Fever anticholinergic SE
Extrapyramidal sx – tardive dyskinesia
Neuroleptic malignant sn

Haloperidol (acute agitation)
Fluphenazine
Loxapine
Thiothixene
Trifluoperazine

Question 3

Atypical antipsychotics

Answer 3

Fewer EPS sx
Fewer anticholinergic SE
Wt gain

Olanzapine
Quetiapine
Risperidone
Aripiprazole
*Clozapine

Block DA, 5HT, alpha and H receptors

Question 4

Uses of antipsychotics

Answer 4

Tx + sx
Block DA in mesolimbic pathway

Psychosis
Severe depression (adjuncts)
Acute mania
Agitation (acute delirium)

Question 5

Neuroleptic SE

Answer 5

Anticholinergic
EPS
Tardive dyskinesia
Neuroleptic malignant sn
Endocrine: increased prolactin
-amenorrhea
-galactorrhea

Question 6

Movement disorders seen in high potency traditional neuroleptics

Answer 6

Within days: acute dystonia – sustained muscle contraction
Tx: add anticholinergic drug

Within first mo: parkinsonian sx – bradykinesia, akinesia

Within first 2 mo: akathisia – restlessness, compulsion to move

Several mo to years – tardive dyskinesia – not EPS

• choreoathetosis of tongue, face, neck, trunk, or limbs
• lip smacking
• irreversible

Question 7

S/S of neuroleptic malignant syndrome

Answer 7

Mental status change – initial sx
-agitated delirium w/ confusion rather than psychosis

Muscle rigidity +/- tremor

Hyperthermia (38-40C)

Rhabdomyolysis over 1-3 days -> AKI

Autonomic instability – tachycardia, high/labile blood pressure, tachypnea, diaphoresis

Question 8

Drugs used to tx neuroleptic malignant syndrome

Answer 8

Dantrolene
Dopaminergic drug:
Bromocriptine – agonist
Amantadine – increase release

Question 9

Common side effects of atypical antipsychotics

Answer 9

Wt gain – H receptors
DM – increased DKA risk
Sedation : H and alpha receptor effects

Clozapine: agranulocytosis!!! Monitor CBC once a week at first
-only refractory cases